MODERN GYNECOLOGY AND REPRODUCTIVE HEALTH PC (NPI# 1962056036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962056036 |
| Entity Type | Organization |
| Organization Name | MODERN GYNECOLOGY AND REPRODUCTIVE HEALTH PC |
| Practice Address |
1407 Union Ave Ste 1401 Memphis TN 38104-3667 |
| Practice Telephone | 9017011777 |
| Practice Fax Number | 9017011778 |
| Mailing Telephone | 9014830619 |
| Enumeration Date | 2019-07-27 |
| Last Update Date | 2019-11-01 |
| Authorized Official Name | DR. SUSAN NORTHEN LACY (PHYSICIAN OWNER) |
| Authorized Official Telephone | 9012890915 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207VG0400X |
Obstetrics & Gynecology Specialization: Gynecology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | Q053117 | 05 |
| Street Address |
1407 UNION AVE STE 1401 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38104-3667 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900367 | Christy White | Recreation Therapist | 1030 Jefferson Ave (rt117), Memphis, TN 38104 | 2020-10-19 |
| 1821615873 | Altiana Carter | Optometrist | 650 New York St, Memphis, Tn 38104, Memphis, TN 38104 | 2020-06-25 |
| 1952898413 | Family To Family Adult Care Service | Chore Provider | 1331 Union Ave Suite 1028, Mempnis, TN 38104 | 2018-04-19 |
| 1326544800 | Kimberly Vestoria Mcclinton | Nurse Practitioner | 2200 Union Ave 1, Memphis, TN 38104 | 2018-04-03 |
| 1649799339 | Benjamin Duhart Jr. | Pharmacist | 1265 Union Avenue- Methodist University Hospital, Ground Floor Pharmacy Administration, Memphis, TN 38104 | 2017-09-13 |
| 1134644982 | Amy Michelle Wise | Nurse Practitioner | 1325 Eastmoreland Ave Ste 500, Memphis, TN 38104 | 2017-08-13 |
| 1316468572 | Jinger Cathey | Social Worker | 1330 Jefferson Ave, Memphis, TN 38104 | 2017-06-28 |
| 1336669183 | Charma May Kavuncu | Social Worker | 1407 Union Ave Ste 1100, Memphis, TN 38104 | 2017-06-22 |
| 1003345398 | Angelica J Dennis | Nurse Practitioner | 1265 Union, Memphis, TN 38104 | 2017-06-08 |
| 1609302546 | Cheryl Beene | Nurse Practitioner | 1211 Union Ave Ste 475, Memphis, TN 38104 | 2017-05-11 |
| Find all providers in zip 38104 | ||||
| Taxonomy Code | 207VG0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Gynecology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457557365 | Barbara A. Duncan-cody Md Pllc | Obstetrics & Gynecology | 1174 Poplar Avenue, Memphis, TN 38105-4805 | 2007-06-26 |
| 1093866733 | Barbara Ann Duncan-cody | Obstetrics & Gynecology | 1174 Poplar Ave, Memphis, TN 38105-4805 | 2007-01-16 |
| 1588299325 | Southwind Gynecology & Wellness Center Pllc | Obstetrics & Gynecology | 3315 Hacks Cross Rd Ste 109, Memphis, TN 38125-8935 | 2020-03-11 |
| 1255602587 | Spg II LLC | Obstetrics & Gynecology | 1264 Wesley Dr, Suite 302, Memphis, TN 38116-6400 | 2012-01-18 |
| 1548200421 | Robert Paul Kline | Obstetrics & Gynecology | 6005 Park Ave, Ste 508, Memphis, TN 38119 | 2006-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598206336 | Stephen Merrick Mintz | Obstetrics & Gynecology | 3124 Natoma Cir, Thompsons Station, TN 37179-9605 | 2017-03-13 |
| 1487190914 | Hormones 4 Life LLC | Obstetrics & Gynecology | 3172 Waterfront Dr, Chattanooga, TN 37419-1541 | 2017-01-08 |
| 1972928604 | Eugene Rudd | Obstetrics & Gynecology | 125 Ashewood Dr, Bristol, TN 37620-5939 | 2014-03-05 |
| 1164793105 | James Thurman | Obstetrics & Gynecology | 5160 Mouse Creek Rd Nw, Cleveland, TN 37312-3228 | 2012-01-23 |
| 1881964815 | David Anthony Rueff | Obstetrics & Gynecology | 7621 Carpenter Rd, Knoxville, TN 37931-1122 | 2012-01-06 |
| 1164724878 | Norman Arnold Mckinnon Jr. | Obstetrics & Gynecology | 911 Scarlett Oaks Rd, Maryville, TN 37801-7403 | 2010-12-01 |
| 1477866820 | New South Medical Enterprises | Obstetrics & Gynecology | 2503 Highway 41a Byp, Clarksville, TN 37043-3902 | 2010-07-14 |
| 1609195965 | Fields Center for Womans Health & Robotic Surgery Pllc | Obstetrics & Gynecology | 10810 Parkside Dr Ste 306, Knoxville, TN 37934 | 2010-05-26 |
| 1396987491 | Kalyani Medicherla Kumar | Obstetrics & Gynecology | 411 Sewell Dr, Sparta, TN 38583-1223 | 2009-04-03 |
| 1962686311 | Harry L Stuber Md PC | Obstetrics & Gynecology | 503 N Cedar Ave, Cookeville, TN 38501-1707 | 2007-12-20 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MODERN GYNECOLOGY AND REPRODUCTIVE HEALTH PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.